Emergency Contact & Medical Information

This information is collected to help us keep you safe during your course.

It will only be accessed if needed for safety or emergency response.

This form is submitted securely via an encrypted connection (HTTPS).

1️⃣Your Details

Please leave blank:

Full Name:

DOB:

Mobile Number:

Course Date:

2️⃣Emergency Contact (Next of Kin)

NOK Name:

Relationship to You:

Emergency Contact Phone No.

Secondary Number (Optional):

3️⃣Medical Information (Optional but Strongly Recommended)

You do not need to provide a full medical history.

Only include information that may be important in an emergency.

A) Medical Disclosure Choice

Required:

(If “no” or “choose not to disclose” → skip to Section 4)

If you prefer to discuss medical or personal information in person, please speak to the instructor privately at the start of the course.

B) Relevant Medical Conditions

Tip: if choosing an option below, click on choice then click in white space away from the other options.

Do you have any of the following?

Asthma Diabetes Heart Condition Epilepsy Severe Allergies Joint or Mobility Issues Mental Health Condition (If relevant to outdoor activities) Other (please specify)

Other:

C) Medication & Emergency Care

Do you carry medication you may need?

If Yes, what do you carry?

Are there any medications or treatments we should avoid?

If yes, please advise:

4️⃣ Consent & Understanding

(Required)

I confirm that:

The information I have provided is accurate to the best of my knowledge

I understand this information will only be used for safety and emergency purposes

I consent to Invenio Training providing first aid and seeking medical assistance if required

Please confirm:

I agree

5️⃣ Data Protection & Reassurance

Your privacy matters.

This form is submitted securely via an encrypted (HTTPS) connection

Information is sent to a secure inbox at nok@inveniotraining.co.uk

Access is restricted to course staff only

Your information will be deleted securely after the course

It will never be shared or used for marketing

6️⃣ Submit

Information submitted via this form is encrypted, kept confidential, used for safety purposes only, and deleted securely after the course.

“I was recommended Bruce's Outdoor Pursuits First Aid L3 course and I can honestly say I too would highly recommend it.

Bruce brings fantastic energy and enthusiam to share his wealth of knowledge and experience on first aid.

Bruce shares his lived experiences and has a way of getting the group feeling comfortable and settled to share their experiences too.

Its also in a wonderful setting with beautiful views. A picture attached. Thanks Bruce, I will be back for my renewal!”

Horizon Coaching